Friday, October 1, 2010

Wheelchair Update

Well, I noticed that in my last post, I shared the news that the Insurance company had determined that I didn't need a wheelchair. That meant that they hadn't paid for it, nor paid for any repairs. So I had been taking care of maintenance for about three years. It wasn't so bad really. Just replacing bolts, cleaning bearings, crimping steel here and there, etc. All this while I was trying to figure out why an insurance company would say a wheelchair wasn't medically necessary. So here's what the hang up was.

As I contacted the call center, I would get a different story each time - fax something here, request something there, etc. Eventually, after faxing multiple departments there, I ended up receiving a copy of all communication between IHC and Aetna from their legal department. It actually took two tries and a conference call with one of their lawyers to finally get the letter of denial and the explanation and the denial of appeal. Since the chair was billed as a package, they denied the whole thing because of three things they said were not necessary:
  • I did not need an 'ultra-light frame'
  • I did not need light wheels (carbon fiber 3 spoke X-cores)
  • I did not need solid core/no flat tires
The reason is that Aetna only covers medical equipment that you need to function at home. All of those things would be necessary for going out doors or transferring into a car. That's not covered. They were saying, in affect, 'Stay home Mr. Townsend. You are disabled.' I couldn't believe that lack of logic, and apparent discrimination. I secured my insurance through my employer but the insurance company would not provide the equipment I needed to retain that employment. I figured I had an open and shut case.

So, acting on advice from my colleague in HR, I called our benefits coordinator at headquarters. She said she was going to look into it and to fax just the denial letter to her. Three days later, I got a call of the IHC wheelchair shop, the 'provider' in Insurance speak:
"Hey Steve this is Shane from the Wheelchair Shop."
"Hey Shane. I'm working with the insurance company. I hope to get payment to you soon. Can you give me a couple weeks?"
"Well, um, that's why I'm calling. We got this weird letter from Aetna today. It says, 'After a voluntary self review, we have determined that all wheelchair claims are covered and we have approved the purchase of the recently specified replacement chair.'"
"Holy Toledo! That's awesome! I know exactly how that happened and it had nothing to do with a 'voluntary self review'."
I called Zelia Magliozzi in Novell Benefits and thanked her to the ends of the earth. She simply said that it shouldn't be a problem any more, chuckled a little, and said goodbye.

So long story, shorter, I'm writing this post in a new chair that fits absolutely perfectly. It's got a light titanium frame with the right push-rims. But most of all - IT FITS! The center of gravity is exactly where I need it so I can push hard AND still wheelie when I want to!

I still have the old chair. But the axle completely failed, the brakes are worn out, the bearings on the right caster are shot, the upholstery is ripped and the solid core tires have worn flat. But other than that, it's still a good backup chair. ;-) This is a good thing to have. Because when one of the caster tires completely ripped off once, I was stuck at home for two days. Now I have no excuse. :-)

There you have it. Up to date on all things wheelchair. I'll try to write a little more about the rest of life. Ta Ta for Now.